=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174059547
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SHARMON S JAMES PSYD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/04/2017
-----------------------------------------------------
Last Update Date | 05/04/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3300 HENRY AVE
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19129-1121
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-924-0684
-----------------------------------------------------
Fax | 215-924-3805
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 841 HIGHLAND AVE TOWNHOME 127
-----------------------------------------------------
City | JENKINTOWN
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19406
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 267-446-5291
-----------------------------------------------------
Fax | 215-924-3805
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC2200X
-----------------------------------------------------
Taxonomy Name | Clinical Child & Adolescent Psychologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------